Suggestions for pain management associated with severe. chronic osteoarthritis that cannot be treated with NSAIDs due to Barrett's Esophagus.

3 weeks post op TKR. Baseline prior to surgery was Fentanyl 75mg patch every other day plus Vicodin. Vicodin discontinued and now Fentanyl is supplemented with 10mg Dilaudid every 4 hours plus Libirum 20mg 3 times daily for alcohol withdrawal.

Want to be functional again, this is not relieving pain and causing cognitive problems. Please help.